Download Headache

Headache
Zheng Dongming
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The most common symptom in clinic
the causes are myriad.
1.intracranial disease
2.extracranial disease
3.functional or psychological disease
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Pathophysiology of
headache
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Pain-sensitive structure:
periosteum of the skull,skin,subcutaneous tissues
muscles,blood vessels
venous sinuses,dural arteries,arteries at the base
of the skull.
The trigeminal,glossopharyngeal,vagus,the
second and third cervical nerves
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Principle :
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1.history is very important in the diagnosis of
headache.
2.physical examinatin
3.CT ,MRI,lumbar puncture.
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Migraine
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Migraine is characterized by an episodic
unilateral throbbing headache . It is a
common idiopathic headache seen in clinic.
2/3~3/4 women
onset early. 55% 20 years of age
90%
40
family histry
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Etiology
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Genetics:approximately three-quarters of patients
who suffer from migraine have close relatives
similarly affected.
Endocrine and metabolic factors:menstruation.
Cheese, chocolate, sherry and red wine are common
precipitants.
Others:bright lights ,loud
noise ,exercise ,hunger,emotional stress and anxiety
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Pathogenesis
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vascular theory:some studies e.g. PET scans
of migraineurs, suggest that the aura is due
to an spreading area of vascoconstriction
over the brain .there is some evidence that
the headache in migraine is due to
subsequent vasodilatation of blood
vessels .the association of stroke with
migraine supports a vascular aetiology.
neuronal theory: aura are associated with
spreading neuronal inhibition which does
not respect vascular territories .neuronal
dysfunction could be the cause of the
spreading vasoconstriction
5-HT.etc
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Clinical features
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A.migraine with Aura(classic Migraine)
prodrome : a vague change in mood or appetite,sensitivity to
light and sound
aura : visual disturbance: Scintillating scotoma, the visual
symptoms usually occupying one visual field, described as zigzag patterns, flashing lights, crescents, motor or sensory
disturbance.mins~1 hour
headache : the headache is often pulsatile and over one side ,
nausea and vomiting ,4~72 hours.
Resolution:weekness
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Clinical
features
B.migraine without Aura(commonic Migraine)
most common one
headache : the headache is often pulsatile and over one
side , nausea and vomiting ,4~72 hours.
C.special type
basilar artery migraine
hemiplegic migraine
ophthalmoplegic migraine
late onset migraine
migraine equivalents
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ophthalmoplegic migraine
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With ophthalmoplegic migraine syndrome, the
headache localises around one eye and it is
followed hours later by a IIIrd or VIth nerve palsy
on that side. The nerve palsy gradually improves
over several days or weeks.
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basilar artery migraine
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Basilar artery migraine is a variety of classical
migraine seen most commonly in young women
and has an aura that is believed to be due to
vertebro-basilar ischaemia.
Features of the aura may
include:vertigo,dysarthria ,ataxia,diplopia ,bilate
ral visual impairment or sensory symptoms.
The proceeding headache is usually occipital.
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hemiplegic migraine
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Hemiplegic migraine is a term used to describe
the migraine syndrome that is associated with a
weakness or sensory loss of the limbs on one
side of the body. The headache usually
precedes the weakness by a day or more. The
limbs gradually return to normal over several
days.Often there is a family history of this type of
migraine, usually with an autosomal dominant
inheritance.
It is a rare form of migraine.
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Diagnosis
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1. Migraine is characterized by periodic headaches
which are typically unilateral and are often
associated with visual disturbance and there is
usually freedom of symptoms between attacks.
2. There is often a family history of migraine.
3. The nervous system examination is normal.
CT,MRI,MRA:normal.
4. Ergotamine is probably effective.
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Diagnostic criteria of common
migraine
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Migraine are episodes of headache lasting 4-72
hours with the following features:
two of the following:
unilateral pain
throbbing quality
aggravated by movement
moderate/severe pain
one of the following:
nausea/vomiting
photo- or phonophobia
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differential diagnosis
The differential diagnosis of migraine is large, but includes
 cluster headache
 carotidynia
 painful ophthalmoplegia
 hypertention,hypotention ,arteriovenous malformations
 dental caries ,sinusitis
 in the elderly, transient ischaemic attacks
 epilepsy
 tumours
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Treatment
Mild:Aspirin,ibuprophen
severe:Ergotamine,dihydroergotamine,code
ine,clorpromazine.
prophylactic
treatment:propranolo,flunarizine,
Ergotamine,etc.precipitating factors.
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